EGFR-TKI联合放疗治疗肺腺癌伴有中枢神经系统转移的meta分析

目的:系统评价表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)联合放疗对比单一EGFR-TKI或单一放疗在治疗肺腺癌合并中枢神经系统转移的有效性。方法:计算机检索PubMed、EMBASE、Medline、Cochrane Library、Clinical trials等数据库,收集2012年1月至2019年4月...     

基于臀部动脉穿支的双叶皮瓣在骶尾部4期压疮中的应用

目的探讨基于臀部动脉穿支的双叶皮瓣在骶尾部4期压疮中的治疗效果。方法本研究为回顾性观察性研究, 选取2021年11月至2023年5月徐州市第一人民医院烧伤整形与创面修复科收治的17例采用基于臀部动脉穿支的双叶皮瓣进行修复的骶尾部4期压疮患者, 男11例、女6例, 年龄(66.65±17.04)岁, 年龄范围为12～82岁。其中13例利用基于臀上动脉穿支的双叶皮瓣、4例利用基于臀下动脉穿支的双叶皮瓣封闭创面。术后随访皮瓣成活情况与供区外观。结果所有双叶皮瓣均无需切断蒂部皮肤和皮下组织, 也不需分离出穿支血管, 均可达到良好的旋转及覆盖效果。15例皮瓣均一期愈合, 术后2周顺利拆线;2例皮瓣因术后受压导致局部皮缘发黑坏死1 cm×3 cm, 经清创换药治疗2周后愈合。术后随访1～17个月, 所有患者压疮无复发, 皮瓣均成活良好, 质地柔软、弹性好、血运良好, 术区仅遗留线性瘢痕。结论基于臀部动脉穿支的双叶皮瓣是修复骶尾部4期压疮的理想皮瓣方案。     

SD大鼠二氧化氮吸入性肺损伤实验研究

目的：探讨二氧化氮（NO2）吸入性肺损伤的机制。方法：采用实验－对照设计方法,对30只SD大鼠肺组织内丙二醛（MDA）、谷胱甘肽（GSH）、总抗氧化能力（T－AOC）进行比较。结果：NO2吸入组SD大鼠肺组织内MDA值显著高于对照组,而T－AOC值则低于对照组,均有显著意义。只有长期NO2吸入组的SD大鼠GSH值显著低于对照组。结论：SD大鼠吸入NO2后,氧化物质与抗氧化物质失衡所导致的氧化性肺损伤,是肺损伤的重要机制。     

Epidemiological investigation of Histoplasma capsulatum infection in China

Objectives To provide reliable information concerning the presence or the absence of Hist oplasma capsulatum (H. capsulatum) infection in China, and data concerning th is respect. Methods Three hundred normal people and 435 hospitalized patients, who lived in Hunan an d Jiangsu provinces, and the Xinjiang Autonomous Region, were tested with yeast -phase histoplasmin (ALK/Berkerley Biologicals Laboratories, USA) and human pur e protein derivative of tuberculin (PPD) on the volar surface of the forearm. A ny reaction to the antigens over 5.0 mm in diameter of induration at 48-72 ho urs was considered positive. Results A total of 138 subjects (18.8%) in 735 patients reacted to histoplasmi n with 5.0-45.0 (9.1±4.3) mm indurations. Significant differences of positive skin reaction rates in norm al subjects were found in Hunan, Jiangsu and Xinjiang (8.9% vs 15.1 % vs 2.1%). The overall positive rate of patients was 25.5%. Patients with t uberculosis ［31.7% (78/246)］ had a significantly higher positive skin reactio n rate in comparison with those suffering from pneumonia ［17.7% (11/62)］, lun g cancer ［20.9% (9/43)］, chronic obstructive pulmonary disease ［17.3% (9/52 )］ and other diseases ［12.5% (4/32)］ (P<0.01). Of 562 cases, 292 case s (52.0%) reacted to PPD with indurations of 5-50 (13.7±4.9)mm in diameter, 63 cases (11.2%) reacted to both histoplasmin and PPD, while 38 cases (6.9%) reacted to histoplasmin but not to PPD. Conclusions The data suggest that there is H. capsulatum herd infection in China. The infection rate in Southeast China is higher than that in the Northwest, and the infection rate of patients with pulmonary tuberculosis is higher than that of no rmal persons and other pneumonopathy patients.     

阻塞性睡眠呼吸暂停综合征与心血管病关系的随访研究

目的调查随访阻塞性睡眠呼吸暂停综合征（OSAS）与心血管病（CVD）的关系。方法自1989年1aY]起入组1868例,其中OSAS患者598例,无OSAS1270例作为对照组,对入组人群每年进行一次体检,以发生CVD为随访终点,如未发生CvD则随访至2009年结束。结果随访期间,OSAS组发生CVD者占83．9％（502／598例）,对照组发生CVD者占28．6％（363／1270例）,两组CVD发生率存在显著统计学差异（P〈0．01）。随访期间死亡率为43．7％（817／1868例）,其中OSAS组死亡率66．2％（396／598例）,对照组死亡率为33．1％（421／1270例）,两组死亡率存在显著统计学差异（P〈0．01）。结论与一般健康人群相比,OSAS患者发生CVD的比例和死亡率均较高。     

双水平气道正压通气对重叠综合征患者心功能及血管内皮功能影响

目的 探讨双水平气道正压通气(BiPAP)对重叠综合征(OS)患者心功能及血管内皮功能的作用机制.方法 对2009年1月至2010年9月南京医科大学附属江宁医院呼吸科睡眠监测室进行多导睡眠监测(PSG)的人群进行筛选,共入选患者120例,其中男87例,女33例,年龄40～53岁,平均(48±4)岁;根据肺功能及PSG检查结果分为:对照组、OSAHS组、COPD组和OS组.所有人群均测定肺功能指标:FEV1占预计值%、FEV1/FVC和峰值呼气流速(PEF%);心功能指标和血管内皮功能指标:内皮素-1、一氧化氮和凝血酶-Ⅲ;PSG指标:AHI、LSaO2及SaO2＜90%时间.OS组患者经BiPAP治疗并随访一个月,记录治疗前后的各项指标并比较.组间比较采用单因素方差分析,组间两两比较采用LSD法,治疗前后比较采用配对t检验.结果 OS组患者FEV1占预计值%为(48±7)%、FEV1/FVC为(46±6)%和PEF%为(47.5±5.3)%均明显低于其他3组(F值为215.47～681.65,均P＜0.05),血管内皮功能明显受损,内皮素-1含量为(48±10)ng/L(F值为46.61～259.12,均P＜0.05);经BiPAP治疗后,OS患者心肺功能及血管内皮功能得到明显改善,FEV1占预计值%、FEV1/FVC及PEF%分别为(58±7)%、(56±7)%及(57.5±2.5)%,内皮素-1含量降至(38±8)ng/L(t值为-17.13～42.06,均P＜0.05).结论 OS可引起明显的低氧血症,从而促使血管内皮功能严重受损.BiPAP治疗能明显改善与呼吸暂停有关的低氧,从而调节血管内皮的功能,可能会成为预防OS合并心血管疾病的重要途径.

Abstract：

Objective To study the mechanism of Bi-level positive airway pressure(BIPAP) on the heart function and the vascular endothelial function of the overlap syndrome(OS). Methods There were 87 males and 33 females (mean age 48 ±4, range 40 -53 years) admitted to the Affliliated Jiangning Hospital respiratory department of Nanjing Medical University. Subjects tested with PSG were allocated to normal,OSAHS, COPD and OS groups by the result of pulmonary function testing. All persons were tested with pulmonary function (FEV1% of predicted, FEV1/FVC% , PEF% ), heart function (Tei index, BNP),vascular endothelial function(ET-1, NO, AT-Ⅲ ) and PSG( AHI, LSaO2, the time of SaO2 ＜90% ). The measurements were repeated in patients with OS after BiPAP treatment and 1 month after follow-up. One-way ANOVA was used for comparison between 2 groups. Post-hoc multiple comparisons of means were performed by using LSD. Paired-samples t Test was used for comparison of data between baseline and post-treatment.Results The FEV1% of predicted, FEV1/FVC%, and PEF% in the OS group were significantly lower than the those in the other groups ( F = 215.47 - 681.65, P ＜ 0. 05 ). The vascular endothelial function was impaired more severely than the other groups ( F = 46. 60 - 259. 12, P ＜ 0. 05 ). The heart function,pulmonary function, and vascular endothelial function were significantly improved after BiPAP treatment( t =-17. 13- 42.06, P ＜ 0. 05 ). Conclusion The vascular endothelial dysfunction is associated with OS.Treatment by BiPAP can improve hypoxia and vascular endothelial function, and therefore may be useful in prevention of cardiovascular disease in OS.     

阻塞性睡眠呼吸暂停综合征与脑血管病关系20年随访研究

目的 调查随访阻塞性睡眠呼吸暂停综合征(OSAS)与脑血管病的关系.方法 对1989年11月至2009年11月南京军区所属3市及地区军队和地方离退休干部休养所进行体检的人群进行随访调查,随访期间每年进行1次体检,检查血压、血脂、血糖、心电图及X线胸片等,发现存在脑血管病表现时行头颅CT检查,以发生脑血管病为随访终点,随访时间为20年.结果 共纳入患者1868例,年龄53～82岁,平均(63±6)岁,其中男956例,平均(65±7)岁,女912例,平均(60±6)岁.其中确诊OSAS者598例(32.0%),纳入OSAS组,其中男496例(82.9%),女102例(17.1%);其余为对照组.随访终点比较结果显示,OSAS组白天嗜睡、头痛、记忆力减退、痴呆及语言障碍等发生率明显高于对照组(P＜0.05).OSAS组276例(46.2%)发生脑血管病,对照组发生150例(11.8%)(P＜0.01).随访期间死亡患者817例,其中OSAS组396/598例(66.2%),对照组421/1270例(33.1%,P＜0.01).随访结束时OSAS组脑血管病患病率为276/598例(46.2%),对照组170/1270例(13.4%,P＜0.01).结论 OSAS患者发生脑血管病可能性较一般人群高,考虑OSAS与发生脑血管病存在相关性,提示OSAS可能是脑血管病的独立危险因素.

Abstract：

Objective To explore the correlation between obstructive sleep apnea syndrome (OSAS) and cerebrovascular disease(CVD). Methods A cohort of 1868 people was screened for OSAS,and followed from November 1989 to November 2009. Annual medical examinations including blood pressure,blood fat, serum glucose, electrocardiogram and chest x-ray were performed. Computer tomography was carried out when CVD, the endpoint of the study, was manifested. Results Among the 1868 elderly people, 598 ( 32.0% ) were confirmed to have OSAS, including 496 ( 82.9% ) males and 102 ( 17. 1% )females. Compared with the non-OSAS group, patients with OSAS had more symptoms including daytime somnolence, headache, decreased ability of memory, aphronesia and allolalia( P ＜ 0. 05 ). CVD occurred in 276(46. 2% )patients of the OSAS group, but in 150( 11.8% , P ＜ 0. 01 )subjects of the non-OSAS group.During the 20-year follow-up, 817 people died, 66. 2% (396/598) in the OSAS group, but 33. 1% (421/1270) in the non-OSAS group ( P ＜0. 01 ). Conclusion Patients with OSAS are more likely to suffer from CVD. OSAS may be an independent risk factor for CVD.     

原位心脏移植一例围手术期处理

１９９４年７月我们成功地完成了１例同种原位心脏移植，术后病人存活至今，并恢复了正常生活，现将围手术期的监测、治疗等处理作一简介，并回顾体会该病人围手术期处理与术后较顺利的可能关系，为进一步把好心脏移植病人围手术期这第一关总结经验。     

中重度阻塞性睡眠呼吸暂停综合征与非酒精性脂肪性肝病相关性研究

目的 :探究中重度阻塞性睡眠呼吸暂停综合征(obstructive sleep apnoea syndrome,OSAS)与非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)关系及脂肪肝指数(fatty liver index,FLI)在OSAS患者诊断中有无脂肪肝的准确性。方法:347例入组患者行多导睡眠监测(polysomnography,PSG),采集患者的血样本行实验室检测,并行腹部超声检查,根据生化指标计算患者FLI,选取FLI在预测NAFLD中的最佳截点值。结果:与非脂肪肝组相比,NAFLD组患者的夜间呼吸暂停低通气指数(apnea hypopnea index,AHI)、氧减指数(oxygen desaturation index,ODI)和睡眠期间脉搏血氧饱和度(pulse oxygen saturation,SpO_2)低于90%时间占总睡眠时间的百分比(T90)明显升高(均P0.05)。NAFLD组患者平均SpO_2和最低SpO_2较非脂肪肝组明显下降(均P0.05)。当FLI截点为52时可准确判断NAFLD,此时受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.827(95%可信区间:0.722～0.914)。结论:在中重度OSA患者中,罹患脂肪肝组夜间低氧程度重于非脂肪肝组。FLI是预测患者有无脂肪肝的良好指标。     

低温等离子辅助改良腭咽成形联合舌减容和鼻腔扩容术对中重度OSAHS的近期疗效和安全性评价

目的 探讨低温等离子辅助改良悬雍垂腭咽成形术(UPPP)、舌减容联合选择性鼻腔扩容术治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的近期疗效、安全性及临床应用价值等。 方法 回顾分析淮安市第二人民医院耳鼻咽喉科2013年10月~2016年5月收治的164例中重度OSAHS患者,按手术方式不同分为观察组和对照组,每组82例患者。观察组在充分围手术期准备的基础上,采取低温等离子辅助改良UPPP、舌体舌根减容以及选择性鼻腔扩容术,对照组常规UPPP加鼻腔扩容术进行治疗。比较两组临床疗效、手术并发症情况等指标。 结果 术后随访6个月,观察组和对照组的总有效率分别为81.7%和62.2%,差异有统计学意义(P<0.05)。随访1年,观察组和对照组的总有效率分别为75.6%和51.2%,差异也有统计学意义(P<0.05)。观察组手术并发症发生率明显低于对照组(P<0.05)。 结论 对有手术适应证的中重度OSAHS行低温等离子辅助改良UPPP联合舌减容和选择性鼻腔扩容术,可取得较为满意的治疗效果,安全性良好,但术后1年以上的远期疗效有待进一步随访观察。